OpenPrescribing Improvement Radar

What this tool does

This tool identifies sub-ICB locations (SICBLs) which have shown substantial improvement across each of our OpenPrescribing measures. The five SICBLs with the largest improvement are reported. We hope this will stimulate discussion with areas that have made effective changes so that successful strategies can be shared.

How it works

We used trend indicator saturation to detect the timing and size of changes of SICBLs against all SICBLs in England. This prototype uses the current criteria to identify improvement:

• SICBLs needed to, on average, be in the highest 20% during the first 6 months of the time period shown.
• SICBLs needed to improve to be, on average, in the lowest 50% of SICBLs during the last 6 months of the period shown.
• The rate of the measure has to decrease by at least 5% across the time period shown (calculated as the difference between the average rate for the first 6 months and the last 6 months).
• There needed to be, on average, at least 50 prescription items written.

You can find more information on the trend indicator saturation methodology we use here, including a podcast on our work with Professor Ben Goldacre.

Interpretation notes

These pilot results are provided for the interest of advanced users, although we don't know how relevant they are in practice. There is substantial variation in prescribing behaviours, across various different areas of medicine. Some variation can be explained by demographic changes, or local policies or guidelines, but much of the remaining variation is less easy to explain.

We are keen to hear your feedback on this tool and how you use it. You can do this by emailing us at bennett@phc.ox.ac.uk. Please do not include patient identifiable information in your feedback.

Table of Contents

- Prescribing of Amino Acid Formula (AAF) and Extensively Hydrolysed Formula (EHF))

- High-cost Angiotensin-Converting Enzyme (ACE) inhibitors

- Anxiolytics and Hypnotics: Average Daily Quantity per item

- Anxiolytics and Hypnotics: Average Daily Quantity per 1000 patients

- Environmental impact of inhalers - average carbon footprint per salbutamol inhaler

- Prescribing of continuous glucose monitoring sensors

- Ciclosporin and tacrolimus oral preparations prescribed generically

- Cost of milk formulae for Cow's Milk Protein Allergy (CMPA) per listed patients aged 0-4

- Co-proxamol

- Desogestrel prescribed as a branded product

- Diltiazem preparations (>60mg) prescribed generically

- Prescribing of dipyridamole

- Direct Oral Anticoagulants (DOACs)

- Proportion of Direct Acting Oral Anticoagulants (DOACs) not prescribed as edoxaban

- Environmental impact of inhalers - prescribing of non-salbutamol Metered Dose Inhalers (MDIs)

- Topical treatment of fungal nail infections

- Prescribing of gabapentin and pregabalin (DDD)

- Glaucoma eye drops prescribed by brand

- Prescribing of gluten free products

- High dose inhaled corticosteroids

- Antibiotic stewardship: Injectable preparations for the treatment of infection

- Levetiracetam prescribed as Keppra

- Long-acting insulin analogues (KTT12)

- Non-preferred NSAIDs and COX-2 inhibitors (KTT13)

- Antibiotic stewardship: volume of antibiotic prescribing (KTT9)

- Antibiotic stewardship: co-amoxiclav, cephalosporins & quinolones (KTT9)

- Antibiotic stewardship: co-amoxiclav, cephalosporins & quinolones (KTT9) prescribing volume

- NHS England Low Priority Treatment - Aliskiren

- NHS England Low Priority Treatment - Amiodarone

- NHS England Low Priority Treatment - Bath and Shower emollients

- NHS England Low Priority Treatment - co-proxamol

- NHS England Low Priority Treatment - dosulepin

- NHS England Low Priority Treatment - doxazosin modified release

- NHS England Low Priority Treatment - Dronedarone

- NHS England Low Priority Treatment - fentanyl immediate release

- NHS England Low Priority Treatment - glucosamine and chondroitin

- NHS England Low Priority Treatment - herbal medicines

- NHS England Low Priority Treatment - homeopathy

- NHS England Low Priority Treatment - lidocaine plasters

- NHS England Low Priority Treatment - liothyronine (including Armour Thyroid and liothyronine combination products)

- NHS England Low Priority Treatment - lutein and antioxidants

- NHS England Low Priority Treatment - Minocycline

- NHS England Low Priority Treatment - Higher Cost Insulin Pen Needles

- NHS England Low Priority Treatment - omega-3 fatty acid compounds

- NHS England Low Priority Treatment - oxycodone and naloxone combination product

- NHS England Low Priority Treatment - perindopril arginine

- NHS England Low Priority Treatment - rubefacients

- NHS England Low Priority Treatment - Silk Garments

- NHS England Low Priority Treatment - tadalafil once daily

- NHS England Low Priority Treatment - paracetamol and tramadol combination

- NHS England Low Priority Treatment - travel vaccines

- NHS England Low Priority Treatment - trimipramine

- NHS England Low Priority Treatment - All Low Priority Treatments

- Pregabalin capsules prescribed as Lyrica

- Methotrexate 10 mg tablets

- Prescribing of nimodipine

- Prescribing of opioids (total oral morphine equivalence)

- High dose opioids per 1000 patients

- High dose opioid items as percentage regular opioids

- Other lipid-modifying drugs

- High-cost PPIs

- Higher dose Proton Pump Inhibitors (PPIs)

- Prescribing of pregabalin (total mg)

- Probiotics that have been removed from the drug tariff

- Short acting beta agonist inhalers

- Possible excess quantities of semaglutide

- Seven Day Prescribing for Long Term Conditions

- High-cost drugs for erectile dysfunction

- Silver dressings

- Soluble/effervescent forms of paracetamol and co-codamol

- Low and medium intensity statins

- Prescribing of tamoxifen

- Toothpaste Prescribing

- Prescribing of high cost tramadol preparations

- Antibiotic stewardship: prescribing of trimethoprim vs nitrofurantoin

- Ulipristal acetate 5mg prescribing for uterine fibroids

- Vitamin B vs thiamine

- Vitamin B complex per 1000 patients

- Zuclopenthixol acetate prescribing in primary care

Prescribing of Amino Acid Formula (AAF) and Extensively Hydrolysed Formula (EHF))

NHS LINCOLNSHIRE

High-cost Angiotensin-Converting Enzyme (ACE) inhibitors

NHS BERKSHIRE WEST

NHS OLDHAM

Anxiolytics and Hypnotics: Average Daily Quantity per item

NHS HEYWOOD, MIDDLETON AND ROCHDALE

Anxiolytics and Hypnotics: Average Daily Quantity per 1000 patients

No organisations met the technical criteria for detecting substantial change on this measure.

Environmental impact of inhalers - average carbon footprint per salbutamol inhaler

NHS HERTS VALLEYS

NHS FRIMLEY

NHS NORTH STAFFORDSHIRE

NHS CHESHIRE

NHS BRISTOL, NORTH SOMERSET AND SOUTH GLOUCESTERSHIRE

Prescribing of continuous glucose monitoring sensors

No organisations met the technical criteria for detecting substantial change on this measure.

Ciclosporin and tacrolimus oral preparations prescribed generically

No organisations met the technical criteria for detecting substantial change on this measure.

Cost of milk formulae for Cow's Milk Protein Allergy (CMPA) per listed patients aged 0-4

NHS SOUTHEND

NHS PORTSMOUTH

Co-proxamol

No organisations met the technical criteria for detecting substantial change on this measure.

Desogestrel prescribed as a branded product

NHS CALDERDALE

NHS WIRRAL

Diltiazem preparations (>60mg) prescribed generically

No organisations met the technical criteria for detecting substantial change on this measure.

Prescribing of dipyridamole

NHS NORTH CUMBRIA

Direct Oral Anticoagulants (DOACs)

No organisations met the technical criteria for detecting substantial change on this measure.

Proportion of Direct Acting Oral Anticoagulants (DOACs) not prescribed as edoxaban

NHS EAST RIDING OF YORKSHIRE

Environmental impact of inhalers - prescribing of non-salbutamol Metered Dose Inhalers (MDIs)

No organisations met the technical criteria for detecting substantial change on this measure.

Topical treatment of fungal nail infections

NHS ROTHERHAM

Prescribing of gabapentin and pregabalin (DDD)

No organisations met the technical criteria for detecting substantial change on this measure.

Glaucoma eye drops prescribed by brand

NHS HALTON

NHS THURROCK

Prescribing of gluten free products

No organisations met the technical criteria for detecting substantial change on this measure.

High dose inhaled corticosteroids

NHS SUNDERLAND

NHS SOUTH TYNESIDE

Antibiotic stewardship: Injectable preparations for the treatment of infection

No organisations met the technical criteria for detecting substantial change on this measure.

Levetiracetam prescribed as Keppra

NHS STOKE ON TRENT

Long-acting insulin analogues (KTT12)

NHS ST HELENS

Non-preferred NSAIDs and COX-2 inhibitors (KTT13)

No organisations met the technical criteria for detecting substantial change on this measure.

Antibiotic stewardship: volume of antibiotic prescribing (KTT9)

NHS NORTH LINCOLNSHIRE

NHS KNOWSLEY

NHS SALFORD

Antibiotic stewardship: co-amoxiclav, cephalosporins & quinolones (KTT9)

NHS NORTH WEST LONDON

NHS IPSWICH AND EAST SUFFOLK

NHS BASILDON AND BRENTWOOD

Antibiotic stewardship: co-amoxiclav, cephalosporins & quinolones (KTT9) prescribing volume

NHS OLDHAM

NHS SUNDERLAND

NHS BASILDON AND BRENTWOOD

NHS England Low Priority Treatment - Aliskiren

NHS CANNOCK CHASE

NHS England Low Priority Treatment - Amiodarone

No organisations met the technical criteria for detecting substantial change on this measure.

NHS England Low Priority Treatment - Bath and Shower emollients

NHS BOLTON

NHS SALFORD

NHS England Low Priority Treatment - co-proxamol

NHS NEWCASTLE GATESHEAD

NHS STAFFORD AND SURROUNDS

NHS SUNDERLAND

NHS England Low Priority Treatment - dosulepin

No organisations met the technical criteria for detecting substantial change on this measure.

NHS England Low Priority Treatment - doxazosin modified release

NHS BURY

NHS OLDHAM

NHS England Low Priority Treatment - Dronedarone

No organisations met the technical criteria for detecting substantial change on this measure.

NHS England Low Priority Treatment - fentanyl immediate release

NHS NORTH TYNESIDE

NHS SOUTH EAST STAFFORDSHIRE AND SEISDON PENINSULA

NHS England Low Priority Treatment - glucosamine and chondroitin

No organisations met the technical criteria for detecting substantial change on this measure.

NHS England Low Priority Treatment - herbal medicines

NHS NORTH EAST ESSEX

NHS England Low Priority Treatment - homeopathy

NHS BRISTOL, NORTH SOMERSET AND SOUTH GLOUCESTERSHIRE

NHS England Low Priority Treatment - lidocaine plasters

No organisations met the technical criteria for detecting substantial change on this measure.

NHS England Low Priority Treatment - liothyronine (including Armour Thyroid and liothyronine combination products)

NHS HALTON

NHS BASILDON AND BRENTWOOD

NHS England Low Priority Treatment - lutein and antioxidants

NHS EAST AND NORTH HERTFORDSHIRE

NHS FRIMLEY

NHS STOKE ON TRENT

NHS EAST RIDING OF YORKSHIRE

NHS England Low Priority Treatment - Minocycline

NHS CAMBRIDGESHIRE AND PETERBOROUGH

NHS CHORLEY AND SOUTH RIBBLE

NHS England Low Priority Treatment - Higher Cost Insulin Pen Needles

NHS BLACKPOOL

NHS BARNSLEY

NHS England Low Priority Treatment - omega-3 fatty acid compounds

NHS THURROCK

NHS NORTH EAST ESSEX

NHS England Low Priority Treatment - oxycodone and naloxone combination product

No organisations met the technical criteria for detecting substantial change on this measure.

NHS England Low Priority Treatment - perindopril arginine

NHS BERKSHIRE WEST

NHS BARNSLEY

NHS CALDERDALE

NHS FRIMLEY

NHS England Low Priority Treatment - rubefacients

NHS ST HELENS

NHS SOUTHPORT AND FORMBY

NHS BARNSLEY

NHS England Low Priority Treatment - Silk Garments

No organisations met the technical criteria for detecting substantial change on this measure.

NHS England Low Priority Treatment - tadalafil once daily

NHS ROTHERHAM

NHS England Low Priority Treatment - paracetamol and tramadol combination

No organisations met the technical criteria for detecting substantial change on this measure.

NHS England Low Priority Treatment - travel vaccines

NHS STOKE ON TRENT

NHS OXFORDSHIRE

NHS COVENTRY AND WARWICKSHIRE

NHS England Low Priority Treatment - trimipramine

NHS CANNOCK CHASE

NHS NORTH STAFFORDSHIRE

NHS BURY

NHS England Low Priority Treatment - All Low Priority Treatments

NHS BASILDON AND BRENTWOOD

NHS BARNSLEY

Pregabalin capsules prescribed as Lyrica

NHS PORTSMOUTH

NHS BLACK COUNTRY AND WEST BIRMINGHAM

NHS NORTH CUMBRIA

NHS WEST LANCASHIRE

Methotrexate 10 mg tablets

No organisations met the technical criteria for detecting substantial change on this measure.

Prescribing of nimodipine

No organisations met the technical criteria for detecting substantial change on this measure.

Prescribing of opioids (total oral morphine equivalence)

No organisations met the technical criteria for detecting substantial change on this measure.

High dose opioids per 1000 patients

NHS NORTH TYNESIDE

NHS SALFORD

NHS SOUTH TYNESIDE

High dose opioid items as percentage regular opioids

NHS SOUTH TYNESIDE

Other lipid-modifying drugs

NHS NORTH EAST ESSEX

High-cost PPIs

NHS SHEFFIELD

NHS ROTHERHAM

Higher dose Proton Pump Inhibitors (PPIs)

No organisations met the technical criteria for detecting substantial change on this measure.

Prescribing of pregabalin (total mg)

NHS NORTH TYNESIDE

Probiotics that have been removed from the drug tariff

NHS WAKEFIELD

Short acting beta agonist inhalers

No organisations met the technical criteria for detecting substantial change on this measure.

Possible excess quantities of semaglutide

No organisations met the technical criteria for detecting substantial change on this measure.

Seven Day Prescribing for Long Term Conditions

No organisations met the technical criteria for detecting substantial change on this measure.

High-cost drugs for erectile dysfunction

NHS LINCOLNSHIRE

NHS HALTON

Silver dressings

NHS SHEFFIELD

Soluble/effervescent forms of paracetamol and co-codamol

NHS DORSET

Low and medium intensity statins

NHS SOMERSET

Prescribing of tamoxifen

No organisations met the technical criteria for detecting substantial change on this measure.

Toothpaste Prescribing

No organisations met the technical criteria for detecting substantial change on this measure.

Prescribing of high cost tramadol preparations

No organisations met the technical criteria for detecting substantial change on this measure.

Antibiotic stewardship: prescribing of trimethoprim vs nitrofurantoin

NHS BOLTON

NHS MANCHESTER

Ulipristal acetate 5mg prescribing for uterine fibroids

No organisations met the technical criteria for detecting substantial change on this measure.

Vitamin B vs thiamine

NHS EAST AND NORTH HERTFORDSHIRE

NHS MID ESSEX

Vitamin B complex per 1000 patients

NHS SOUTHPORT AND FORMBY

NHS SOUTH SEFTON

NHS BARNSLEY

NHS ST HELENS

NHS KNOWSLEY

Zuclopenthixol acetate prescribing in primary care

No organisations met the technical criteria for detecting substantial change on this measure.